Stroke Facts and Statistics

Study Notes

Stroke is the third leading cause of death, ranking behind cardiac disease and all forms of cancer.
It is a leading cause of serious, long-term disability.
Every 45 seconds, someone in the USA has a stroke, and every 3 minutes, someone dies of one.
Stroke can account for about half of all hospital admissions for acute neurological disease (depending on the country).
The economic burden of this disease is tremendous, with a 2017 figure of 60 billion Euros (EU country study) per year.

High Blood Pressure (Hypertension) - risk doubles with every 7.5mm increase in diastolic BP.
Heart Disease
Vascular Disease
Diabetes Mellitus
Diet/High Cholesterol
Alcoholism
Poor Health
Smoking
Contraceptive Pill (3 times increased risk)
COVID-19 (21% of SARS-CoV-2/Covid-19 patients have both neurological symptoms and thromboembolic events)

Cytokine Storm – proinflammatory cytokines (role of IL6)
Coagulation dysfunction: triggers coagulation/blood clot pathway
CNS invasion: infects endothelial cells/Blood Brain Barrier
Angiotensin converting enzyme 2 (ACE2) expressed in heart/blood vessels/gut/lung/kidneys
ACE2 in Brain: on neurons, glial cells, cerebral blood vessel endothelium
Covid-19 binds to ACE2 and “hijacks” to gain CNS entry via ACE2
ACE2 expression 3X higher in adult males to females

Physiotherapy
Re-Open the vascular occlusion with thrombolytic agents (clot-busters) - Tissue Plasminogen Activator (t-PA), Streptokinase/Urokinase
Prevent reocclusion – antithrombolytic therapy - Aspirin
Many failed Clinical Trials!
Future therapies?

Only applicable to “large vessel” strokes
Small subgroup (less than 2%) of stroke patients who fail to improve following intravenous Tissue Plasminogen Activator (t-PA) where the blocked vessel fails to open

Proposal to reduce ischaemic heart disease and stroke by 1/3rd in over 55-year-olds, gaining 11 years of life
Proposed formulation: Statin (cholesterol-lowering) + 3 BP lowering agents + Folic acid (to lower homocysteine) + Aspirin (antiplatelet)

Clinical trials in stroke and cardiovascular disease
In 2015, over 3500 different interventions including drug, surgery, aftercare, and nothing!
In 2020, 1908 stroke trials registered with the clinical trial center listing: “centerwatch”/search “stroke”: www.centerwatch.com

Sekerdag et al. (2018) - Cell death mechanisms in stroke and novel molecular and cellular treatment options
Wu and Tymianski (2018) - Targeting NMDA receptors in stroke: new hope in neuroprotection
Jayaraj et al. (2019) - Neuroinflammation: friend and foe for ischemic stroke
Das et al. (2019) - Treatment approaches to Lacunar Stroke
Chrostek et al. (2019) - Efficacy of stem cell-based therapies for stroke